No abstract

Because of widespread distribution of the influenza A (H1N1) 2009 monovalent vaccine (pH1N1 vaccine) and the prior association between Guillain-Barré syndrome (GBS) and the 1976 H1N1 influenza vaccine, enhanced surveillance was implemented to estimate the magnitude of any increased GBS risk following administration of pH1N1 vaccine. The authors conducted active, population-based surveillance for incident cases of GBS among 45 million persons residing at 10 Emerging Infections Program sites during October 2009-May 2010; GBS was defined according to published criteria. The authors determined medical and vaccine history for GBS cases through medical record review and patient interviews. The authors used vaccine coverage data to estimate person-time exposed and unexposed to pH1N1 vaccine and calculated age- and sex-adjusted rate ratios comparing GBS incidence in these groups, as well as age- and sex-adjusted numbers of excess GBS cases. The authors received 411 reports of confirmed or probable GBS. The rate of GBS immediately following pH1N1 vaccination was 57% higher than in person-time unexposed to vaccine (adjusted rate ratio = 1.57, 95% confidence interval: 1.02, 2.21), corresponding to 0.74 excess GBS cases per million pH1N1 vaccine doses (95% confidence interval: 0.04, 1.56). This excess risk was much smaller than that observed during the 1976 vaccine campaign and was comparable to some previous seasonal influenza vaccine risk assessments.

Declaration of interests KNA serves on the scientific advisory board of TrioHealth, Inc.. MJG has served as an ad hoc member of Canadian HIV Advisory Boards of Merck, Gilead and ViiV. RDM has previously consulted for Medscape. MJS has received grants from Gilead and, formerly, Merck. The remaining authors have no conflicts of interest to disclose.

Approximately 10% of deaths in PWHIV prescribed ART during 1995-2009 were attributable to cancer, but this fraction increased over time. A large proportion of cancer-attributable deaths were associated with non-Hodgkin lymphoma, lung cancer, and liver cancer. Deaths due to NADCs will likely grow in importance as AIDS mortality declines and PWHIV age.

Key Points Question Are the rate and risk of COVID-19 breakthrough infections higher among vaccinated people with vs without HIV in the United States through December 31, 2021? Findings In this cohort study of 113 994 patients, risk of breakthrough infection was low overall (3.8%) but 28% higher in people with vs without HIV. The breakthrough rate was also higher in people with vs without HIV (55 cases per 1000 person-years vs 43 cases per 1000 person-years). Meaning The higher rate and risk of infection in people with HIV observed in this study suggests comprehensive inclusion of this population in recommendations for additional primary doses in immunocompromised groups.